Review the charge nurse's shift updates and determine how the changing acuity should affect assignment and delegation decisions.
Trend
Choose your responses, then check the answer.
Explanation
Assignments must be revised when a client's condition changes. New stridor after thyroidectomy is an airway emergency and is the update that most strongly changes the plan. The charge nurse should send an experienced RN to assess and activate emergency response while redistributing stable tasks. A routine daily weight for a stable client can be delegated to the unlicensed assistive person, with the RN retaining responsibility to interpret and act on the result. Initial assessment, clinical judgment, and care of an unstable client cannot be delegated.
Trend to recognize The assignment that was reasonable at 0700 is no longer safe after a client develops stridor. Management of care requires reassessment as acuity and staff availability change.
Priority response Place an experienced RN at the bedside, activate the emergency pathway, and redistribute predictable care for stable clients. The charge nurse may need to take a direct-care role while preserving oversight of the unit.
Delegation rule Delegate the task, not the nursing judgment: stable and predictable work may move; assessment and instability stay with the RN.
Why the alternatives fail Discharge teaching and routine weights matter, but they do not outrank an airway emergency. An unlicensed assistive person may collect a routine weight but does not interpret fluid-status changes or assess stridor. Keeping the original assignment despite a major acuity change ignores supervision responsibility.
Source
12026 NCLEX-RN Test Plan: Management of Care
2NCSBN Delegation Resources
SettingA medical-surgical charge nurse is coordinating care with two registered nurses, one licensed practical or vocational nurse, and one unlicensed assistive person. Staffing and client acuity change during the first hour of the shift.
lactate clearance — Percent decrease in lactate from initial to follow-up; over 10-20 percent suggests adequate resuscitation.
SOFA score — Sequential Organ Failure Assessment score; tracks 6 organ systems in sepsis.
mottling — Skin marbling pattern over knees suggesting hypoperfusion; correlates with mortality.